When A Major Medical Financing Study Gets It Wrong

A major investigative group recently released a report claiming that many doctors are being corrupted by payments from the pharmaceutical industry.

The report, called “Dollars for Docs,” was issued by the group ProPublica. It compiled a database of $257.8 million in payments to 17,700 doctors by seven drug companies. The payments, ProPublica concludes, “raise ethical issues.”

This study has some serious flaws. There are important distinctions in the kinds of payments made to doctors that the study ignores. The result of ProPublica’s demonizing report is to undermine a vital doctor-industry relationship that facilitates drug innovation and the creation of new cures and treatments.

The ProPublica report does not distinguish between rare private payments for genuinely pernicious activities–like payola, which is already a serious crime–and those that finance crucial activities, like education and laboratory work.

The pharmaceutical industry seeks advice from physicians to improve its products. In turn, doctors advise companies on how to make drugs safer and more effective. Physicians are in a unique position to know what dosages and drug delivery methods work best because they are treating actual patients. Their input is crucial to the process of designing clinical trials and research projects.

ProPublica, however, seems to assume that any health care professional communicating with the drug industry is, by definition, just trying to make a fast buck.

The truth is that most doctors interact with drug companies for good reasons. Indeed, many doctors continue to rely on drug companies for continuing education–especially with regards to particular drugs–because they believe it’s important for good patient care.

Endocrinologist J. Michael Gonzales-Campoy says that interaction between physicians and drug companies is beneficial. He wrote in the journal Endocrine Practice that “there is no way that we would be this far advanced in American medicine if it were not for that working relationship.”

One of the most widely touted ProPublica findings is that Harvard-affiliated doctors and researchers received 45% of payments given to all Massachusetts doctors over the last two years.

This finding really shouldn’t come as a surprise. Doctors affiliated with Harvard are generally experts at the top of their fields. They’re extremely knowledgeable and want to share their expertise with others. Of course private firms would be particularly eager to work with them and to compensate them for their time.

The biggest cause for concern is that this study could scare doctors into ending work with drug companies. Such a move would shut down vital information pathways and compromise future medical innovation.

ProPublica even encourages patients to find their personal doctor in the data. “This may put your next prescription in a different light,” editor Stephen Engelberg ominously intones. “Let us know if you feel you were pushed to try a newly available drug,” ProPublica asks, acting as if a doctor prescribing a new treatment that could benefit a patient is a bad thing.

Collaboration is the hallmark of so many innovative fields, and medicine is no exception.

Of course, doctors and firms that step over the line to put patients at risk should be punished. To prevent corruption, private firms have taken steps on their own to better identify doctors that might misuse industry dollars. In fact, just this month, several large pharmaceutical companies announced plans to improve the screening process for doctors that promote their products.

But the genuine teamwork that’s made the U.S. pharmaceutical industry the envy of the world should be encouraged.

Unfortunately, this study is the tip of the iceberg of baseless attacks on doctors. The National Institutes of Health won’t let its scientists correspond with scientists in the private sector. That means experts working for the government can’t share their findings with their colleagues who work for pharmaceutical or biotechnology firms.

Pharmaceuticals save and extend lives. Just in the last three decades, life expectancy for cancer patients has increased by three years, and 83% of that gain is because of cutting-edge new treatments. In general, drugs account for about half to 60% of increases in survival rate since 1975.

These gains were made because of collaborations between physicians, researchers and drug developers. Unethical relationships are just that–unethical–and all participating parties should be punished. But the ProPublica report seems to assume that all doctor-industry interactions are corrupt. That’s simply not the case. In fact those interactions often lead to life-saving medications.